Scottish Government Equality Outcomes: Pregnancy and Maternity Evidence Review

12 Health

12.1 Evidence suggests that pregnant women can experience discrimination in health care on the basis of their age, ethnicity, or status as a migrant or asylum seeker. There is also some evidence to suggest that obese women, and women with mental health issues or learning disabilities, suffer discrimination during pregnancy within the health care system in the UK.

Teenage pregnancy

12.2 Teenage pregnancy often has negative health outcomes for both parents and their children⁸⁵: for example, teenage mothers are more likely to suffer post-natal depression.

12.3 Research focussing on young people's experiences of maternity and health services in Scotland has found that pregnant women in their teens suffered negative stereotypes about teenage parents during both pre- and post-natal care. A qualitative study⁸⁶ revealed, however, that young expectant fathers were more likely than expectant mothers in the same age-range to report negative experiences of healthcare.

Pregnancy and obesity

12.4 Two studies published in 2011 indicate that obese women experience discrimination with respect to maternity and post-natal care. Obesity in pregnancy is associated with increased risks for mother and child, including increased maternal morbidity. In a qualitative study of obese expectant mothers, women reported feelings of humiliation based on their weight and the high-risk status of their pregnancy⁸⁷. As with teenage pregnancy, there is a stigma associated with obesity in pregnancy which impacts negatively on the experiences of obese women when accessing maternal healthcare. These findings are confirmed by another qualitative study⁸⁸ which concluded that healthcare services should not "further embed the social stigma" that obese pregnant women face during prenatal care (p.177).

Smoking

12.5 Smoking during pregnancy has declined to a reported level of 19.3% in 2011, from 29.0% in 1995. Women under 20 years of age report the highest current levels of smoking at NHS booking appointments⁸⁹. Smoking and alcohol consumption while pregnant increase the risk of low birth weight and infant death⁹⁰. Evidence suggests that one in four women smoke during pregnancy and a similar proportion drink alcohol (ibid). Women in Scotland are more likely to consume alcohol during pregnancy if they are white or live in a rural area, and the likelihood increases with rising income and social class (ibid). However, women are more likely to smoke if they are in lower socio-economic groups (ibid).

12.6 A quantitative study investigating the impact of Scotland's ban on smoking on pregnancy outcomes (specifically pre-term delivery and babies born small for their gestational age) indicated that risks of these outcomes were reduced by the legislation⁹¹. However, qualitative research evidence suggests that the smoking ban has not reduced the levels of home smoking among working women who care for children, and so children's health is still negatively affected by smoking⁹².

Pregnancy, learning disabilities, and mental health

12.7 Social stigma increases the vulnerability of women with learning disabilities when pregnant. Mothers with learning difficulties have lower self-esteem⁹³. Pregnancy itself is known to increase women's risk of depression and anxiety, a key locus of gendered health inequalities⁹⁴. Evidence suggests that the stigma of mental ill-health translates into discrimination and judgmental behaviour from healthcare staff which negatively impacts on women's engagement with healthcare services (ibid). Disengagement from health services and other forms of ante-natal and post-natal support increases the risk of maternal and infant mortality (ibid).

12.8 A recent case in the English Court of Protection system has highlighted the inter-relation between learning disability, chronic medical conditions, and a woman's right to choose whether to continue or terminate a pregnancy.⁹⁵ The court ruled that the woman should be permitted to continue her pregnancy.

Pregnant migrants, asylum seekers and refugees

12.9 Migrant, asylum-seeking and refugee women are more at risk of mental health problems in pregnancy. Specifically, post-natal depression may affect up to four times as many migrant women than native born women in developed country settings⁹⁶. This is explained by the fact that the 'risk factors' for post-natal depression (lack of social support, stressful life events and a previous history of depression) are more common among this group. Ethnic minority women also suffer perinatal depression (depression during and after pregnancy) more often than white women⁹⁷.

Healthcare in pregnancy and maternity

12.10 Treatment of women during pregnancy, labour and maternity falls under provisions of domestic and international equality and human rights legislation. Women are therefore required to be treated with fairness, dignity and respect at all stages. General Medical Practitioners (GPs) are advised to ensure effective treatment and engagement with women at all stages of pregnancy and maternity⁹⁸. A recent decision by the Scottish Public Services Ombudsman upheld a complaint against the Southern General Hospital Glasgow about a woman's treatment during labour⁹⁹.